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Clarification: Physician visit and prescription drug limits to remain in place July 1, 2018

During the 2018 session of the Mississippi Legislature, a number of amendments were made to the law governing the types of care and services reimbursed by the Mississippi Division of Medicaid (DOM). Senate Bill 2836 provided a variety of new flexibilities to DOM, including the removal of the statutory cap on physician visits per year and prescription drugs per month. DOM officials are grateful to have received these additional flexibilities from state legislators, and the agency is carefully exploring responsible reforms that will be in the best interest of Mississippi Medicaid beneficiaries and taxpayers. As the agency researches these possibilities, Medicaid-enrolled providers, beneficiaries and other stakeholders should be advised the current DOM policy specifying 12 physician visits per year and five prescriptions per month remains in place and will not change July 1, 2018.

It is important to note that beneficiaries who are eligible for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, which includes all children up to age 21, will continue to receive any medically necessary services in accordance with federal law and Miss. Admin. Code, Part 223, without regard to service limitations and with prior authorization. Additionally, beneficiaries enrolled in DOM’s coordinated care program, MississippiCAN, who are not EPSDT-eligible, may receive enhanced benefits, such as unlimited physician visits and additional prescription drugs.

If you have questions, please contact us toll-free at 800-421-2408 or 601-359-6050.

Posted June 8, 2018